准分子激光角膜上皮瓣下磨镶术矫治近视

Effects of LASEK for the Treatment of Myopia

【目的】评价准分子激光角膜上皮磨镶术（LASEK）矫治近视的手术特点和临床疗效。【方法】采用20%乙醇浸泡角膜上皮10-12 s制作上皮瓣,以Zeiss Mel-80准分子激光仪进行激光切削,术后配戴绷带式角膜接触镜3-6 d,术后随访6-12个月,观察术后症状,角膜上皮瓣愈合特点,眼压Haze形成情况等。【结果】共有115例224眼随访6-12个月,平均等效球镜为（-9.47±0.531）D;224只眼制作完好的上皮瓣,直径为8-9mm,上皮瓣蒂位于上方。术后1 d检查,31只眼中度刺激症状,其余患者术后刺激症状轻微,可以耐受。术后3d内刺激症状基本消失。上皮瓣基本透明177只眼,轻度水肿43眼,4眼中度水肿。取角膜接触镜时,224只眼角膜上皮愈合完好。术后3个月,6个月,12个月所有患者眼压均在正常范围。术后1个月泪液分泌试验下降,术后3个月逐渐恢复。术后Haze反应分-10.0D以上和-10.0D以下两组对比,Haze2级及Haze2级以上相比差异有显著性（P〈0.01）。Haze反应男性多于女性。两组病例术后3个月检查,裸眼视力0.4-1.0,未见最佳矫正视力下降。【结论】-10.00D内的患者行LASEK手术,具有术后刺激症状轻,上皮愈合好,Haze反应轻等优点。其远期临床疗效及对Haze的形成作用仍需更多病例和更长时间的随访和研究。

[Objective] To evaluate the effects of laser-assisted subepithelial keratomileusis （LASEK） for the treatment of myopia. [Methods]In this prospective study of case series, LASEK was performed in 224 eyes （115 patients） with contact lens（CLs） for 3 to 6 days after surgery and followed up for 6 to 12 months. The postoperative symptom, epithelial flap, intraocular pressure and haze formation were investigated. The application time of alcohol for LASEK was 10 to 12 seconds. The hinge was routinely at 11 to 12 o＇clock by Zeiss Mel-80 laser machine. [Results] 224 eyes （115 patients） were included with mean equal sphinct lens about -0. 947±0. 531 diopter. The diameter of epithelial flap was 8-9 minimeter. On the first day after surgery only 31 eyes had modetate insulting symptom and disappeared in 3 days. Epithelial flaps were nearly transparent in 177 eyes, slightly edema in 43 eyes and moderate edema in 4 eyes. All epithelial flaps were transparent when taking off the CLs. The intraocular pressure of all eyes was normal at 3,6 and 12 months. Schiemer test decreased at 1 month and recovered at 3 months after LASEK. Haze formation in eyes above - 10 diopter and below - 10 diopter were compared. There were statistically significant differences of second grade and more than second grade in two groups （ P 〈0.01）. And haze formation showed more in male than that in female. All uncorrected visual acuity were 0.4-1.0 and no eye lost best corrected Snellen visual acuity at 3 months postoperative. [Conclusion] Patients below -10 diopter performed LASEK showed less insulting symptom, better epithelial flap healing and lighter haze formation. But further clinical outcome needs advanced study.